Do we need a European Health Union?
Authors: None The Lancet Public Health
Journal: The Lancet Public Health (2022)

In the past 2 years, the resilience of the European health systems has been tested as never before. Europe was not prepared for public health emergencies. Health systems struggled, particularly in the early stages of the COVID-19 pandemic, plagued with shortages of beds, medical equipment (such as ventilators and personal protective equipment), and staff. To reinforce Europe's capacity to respond to new cross-border health threats, in October, 2020, EU Commission President Ursula von der Leyen called for a European Health Union—to better protect the health of its citizens, equip the EU and its Member States to better prevent and address future pandemics, and improve resilience of health systems. A key pillar was the launch of the European Health Emergency Preparedness and Response Authority (HERA). This month, the European Parliament adopted the proposed regulations on serious cross-border health threats and on extending the mandate of the European Centre for Disease Control (ECDC). Complementing HERA and a renewed mandate for the European Medicines Agency, these are important building blocks for a European Health Union. This issue of The Lancet Public Health showcases two of the most important predicaments for public health in Europe: antimicrobial resistance (AMR) and climate change. The comprehensive analysis of AMR burden in the WHO European region by Mohsen Naghavi and colleagues covers 23 bacterial pathogens and 88 pathogen–drug combinations and estimates that 541 000 deaths were associated with bacterial AMR and 133 000 deaths were attributable to bacterial AMR in the region in 2019. Countries with developed, approved, financed, and implemented national AMR action plans had lower rates of AMR burden than countries without. Meanwhile, extreme weather events are becoming the new norm, fuelling disasters and taking lives and livelihoods. 2022 was the hottest summer in Europe on record. Increasing health-related exposures and impacts from climate change in Europe underscores the urgent need for mitigation and effective adaptation strategies. Responding to this need, the Lancet Countdown on Health and Climate Change established a transdisciplinary research collaboration for monitoring progress in Europe, incorporating 33 indicators, covering all 38 European Environment Agency members and the UK. Their first report shows that the health risks for almost all tracked indicators are increasing in Europe. Heatwave exposure and heat-related mortality are rising. The environmental suitability for the transmission of water-borne and vector-borne diseases is being affected, while allergen indicators show that the flowering seasons of allergenic species are starting 10–20 days earlier. 94% of the European population live at PM2·5 concentrations higher than the WHO guideline. Decarbonisation for electricity generation, heating, and transport needs to accelerate to reach net-zero carbon emissions. Given the scale of these overlapping and interconnecting issues, ambition at the continent level seems a minimum. Another important concern for Europe should be its health-care workforce. The WHO report Health and care workforce in Europe: time to act, published in September, documents substantial health-care workforce challenges. “Personnel shortages, insufficient recruitment and retention, migration of qualified workers, unattractive working conditions, and poor access to continuing professional development opportunities are blighting health systems,” for Hans Kluge, WHO Regional Director for Europe. “A ticking timebomb”. Worryingly, this is a clear threat to Universal Health Coverage for Europe. Many aspects of Europeans’ health are influenced and affected by transnational forces such as the environmental and commercial determinants of health. Not all public health threats can be prevented or tackled at a national level, some (and increasingly so) require transnational approaches. A European Health Union to support, not replace, national public health efforts to address the determinants of health is crucial. Would European citizens want such a Union? At times when some seem to prefer isolationism and nationalism, one could wonder. The endorsement by the European Parliament for extending ECDC's mandate and regulating EU responses to serious cross-border health threats by a resounding majority gives tangible reason for hope. A European Health Union could support its members to tackle current and future public health threats, and should broaden its ambition towards addressing the social, economic, commercial, and environmental determinants of health and wellbeing.